Abstract
Radial head prosthetic replacement is indicated in case of comminuted fracture not amenable to internal fixation, especially when the radial head fracture is part of a pattern of lesions configuring a complex instability of the elbow. Thirty-one SBi radial head prostheses were implanted in 30 patients (one bilateral simultaneous fracture) over a 2 years period. In 10 patients, the mean time from trauma to surgical treatment was 2.4 days, while the remaining 20 patients were treated as “second opinion” cases presenting with elbow stiffness or instability after an average of 19 days from trauma. The implants were monopolar in 12 cases and bipolar in 19. The clinical results were evaluated through the Mayo Elbow performance scoring system. At an average follow-up of 2 years (range 13–36 months), the mean MEPS was 90 points (range 65–100). At late radiographic analysis, radiolucent lines around the stem were found in 11 of the 31 cases. Heterotopic ossifications were found in 14 cases. Bone resorption was observed in 9 cases. Two of the 31 prostheses were removed after 16 and 20 months, in one case to correct stiffness in pronation/supination, in the other one for asymptomatic aseptic mobilization. These short-term results are satisfactory, especially when considering that they were obtained in complex elbow lesions treated in many cases at a delayed stage. Our preference over time went more and more to bipolar implants, but from a comparison of the results we could find no evidence of a superiority of bipolar or monopolar implants. The evolution of these prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.
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Morrey BF (2000) Radial head fracture. In: Morrey BF (ed) The elbow and its disorders, 3rd edn. WB Saunders, Philadelphia, pp 341–364
Morrey BF, O’Driscoll SW (2009) Complex Instability of the Elbow. In: Morrey BF (ed) The elbow and its disorders, 4th edn. Saunders Elsevier, Philadelphia, pp 450–462
O’Driscoll SW (2009) Elbow dislocations. In: Morrey BF (ed) The elbow and its disorders. 4th edn. Saunders Elsevier, Philadelphia, pp 436–449
Beingessner DM, Dunning CE, Stacpoole RA, Johnson JA, King GJ (2007) The effect of coronoid fractures on elbow kinematics and stability. Clin Biomech (Bristol, Avon) 22(2):183–190. (Epub 2006 Nov 13)
Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ (2001) Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 83(A12):1823–1828
Zunkiewicz MR, Clemente JS, Miller MC, Baratz ME, Wysocki RW, Cohen MS (2012) Radial head replacement with a bipolar system: a minimum 2-year follow-up. J Shoulder Elbow Surg 21(1):98–104
Yian E, Steens W, Lingenfelter E, Schneeberger AG (2008) Malpositioning of radial head prostheses: an in vitro study. J Shoulder Elbow Surg 17(4):663–670
Van Riet RP, Morrey BF (2008) Documentation of associated injuries occurring with radial head fracture. Clin Orthop Relat Res 466(1):130–134
Van Riet RP, Van Glabbeek F, Morrey BF (2009) Radial head fractures. In: Morrey BF, Sanchez-Sotelo J (eds) The elbow and its disorders, 4th edn. Saunders Elsevier, Philadelphia, pp 359–388
Regan W, Morrey B (1989) Fractures of the coronoid process of the ulna. J Bone Joint Surg Am 71(9):1348–1354
Morrey BF, An KN, Chao EYS (1993) Functional evaluation of the elbow. In: Morrey BF (ed) The elbow and its disorders, 2nd edn. Saunders, Philadelphia, WB, pp 36–59
Broberg MA, Morrey BF (1986) Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am 68(5):669–674
Ilahi OA, Strausser DW, Gabel GT (1998) Post-traumatic heterotopic ossification about the elbow. Orthopedics 21(3):265–268
Ilahi OA, Bennett JB, Gabel GT, Mehlhoff TL, Kohl HW 3rd (2001) Classification of heterotopic ossification about the elbow. Orthopedics 24(11):1075–1077
Moon JG, Berglund LJ, Domire Z, An KN, O’Driscoll SW (2009) Stem diameter and micromotion of press fit radial head prosthesis: a biomechanical study. J Shoulder Elbow Surg 18(5):785–790
Rowland AS, Athwal GS, MacDermid JC, King GJ (2007) Lateral ulnohumeral joint space widening is not diagnostic of radial head arthroplasty overstuffing. J Hand Surg Am 32(5):637–641
Shors HC, Gannon C, Miller MC, Schmidt CC, Baratz ME (2008) Plain radiographs are inadequate to identify overlengthening with a radial head prosthesis. J Hand Surg Am 33(3):335–339
Morrey BF, Harter GD (2009) Ectopic ossification about the elbow. In: Morrey BF, Sanchez-Sotelo J (eds) The elbow and its disorders, 4th edn. Saunders Elsevier, Philadelphia, pp 472–486
Grewal R, MacDermid JC, Faber KJ, Drosdowech DS, King GJ (2006) Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. J Bone Joint Surg Am 88(10):2192–2200
Harrington IJ, Sekyi-Otu A, Barrington TW, Evans DC, Tuli V (2001) The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review. J Trauma 50(1):46–52
Shore BJ, Mozzon JB, MacDermid JC, Faber KJ, King GJ (2008) Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty. J Bone Joint Surg Am 90(2):271–280
Popovic N, Lemaire R, Georis P, Gillet P (2007) Midterm results with a bipolar radial head prosthesis: radiographic evidence of loosening at the bone-cement interface. J Bone Joint Surg Am 89(11):2469–2476
Burkhart KJ, MattyasovszkSy SG, Runkel M, Schwarz C, Küchle R, Hessmann MH, Rommens PM, Lars MP (2010) Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elbow Surg 19(7):965–972
Celli A, Modena F, Celli L (2010) The acute bipolar radial head replacement for isolated unreconstructable fractures of the radial head. Musculoskelet Surg 94(Suppl 1):S3–S9
O’Driscoll SW, Herald JA (2012) Forearm pain associated with loose radial head prostheses. J Shoulder Elbow Surg 21(1):92–97
Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW (2012) Effect of stem length on prosthetic radial head micromotion. J Shoulder Elbow Surg (Epub ahead of print)
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Rotini, R., Marinelli, A., Guerra, E. et al. Radial head replacement with unipolar and bipolar SBi system: a clinical and radiographic analysis after a 2-year mean follow-up. Musculoskelet Surg 96 (Suppl 1), 69–79 (2012). https://doi.org/10.1007/s12306-012-0198-z
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DOI: https://doi.org/10.1007/s12306-012-0198-z